Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis

Han, Guohong; Qi, Xingshun; He, Chuangye; Yin, Zhanxin; Wang, Jianhong; Xia, Jielai; Yang, Zhiping; Bai, Ming; Meng, Xiangjie; Niu, Jing; Wu, Kaichun; Fan, Daiming

doi:10.1016/j.jhep.2010.06.029

« Previous Next »Journal of Hepatology
Volume 54, Issue 1 , Pages 78-88, January 2011

Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis

Guohong Han
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Corresponding author at: Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 15 West Changle Road, Xi’an 710032, China. Fax: +86 29 82539041.
- These authors contributed equally to this work.
Xingshun Qi
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- These authors contributed equally to this work.
Chuangye He
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Zhanxin Yin
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Jianhong Wang
- Department of Ultrasound, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Jielai Xia
- Department of Medical Statistics, Fourth Military Medical University, Xi’an, China
Zhiping Yang
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Ultrasound, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Ming Bai
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Xiangjie Meng
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Jing Niu
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Kaichun Wu
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Ultrasound, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Daiming Fan
- Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Department of Ultrasound, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
- Correspondence to: Daiming Fan, State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 15 West Changle Road, Xi’an 710032, China. Fax: +86 29 82539041.

Received 31 March 2010; received in revised form 4 June 2010; accepted 5 June 2010. published online 31 August 2010.

Background & Aims

Data on the management of portal vein thrombosis (PVT) in patients with decompensated cirrhosis are extremely limited, particularly in the cases of the transjugular intrahepatic portosystemic shunt (TIPS). We assessed the outcome of TIPS for PVT in patients with cirrhosis and symptomatic portal hypertension and determined the predictors of technical success and survival.

Methods

In the retrospective study, 57 consecutive patients receiving TIPS were enrolled between December 2001 and September 2008. All were diagnosed with chronic PVT, and 30 had portal cavernoma. Indications for TIPS were variceal hemorrhage (n=56) and refractory ascites (n=1).

Results

TIPS were successfully placed in 75% of patients (43/57). The independent predictors of technical success included portal cavernoma, and the degree of thrombosis within the main portal vein (MPV), the portal vein branches, and the superior mesenteric vein. Only one patient died of severe procedure-related complication. The cumulative 1-year shunt dysfunction and hepatic encephalopathy rates were 21% and 25%, respectively. The cumulative 1- and 5-year variceal re-bleeding rates differed significantly between the TIPS success and failure groups (10% and 28% versus 43% and 100%, respectively; p=0.0004), while the cumulative 1- and 5-year survival rates were similar between the two groups (86% and 77% versus 78% and 62%, respectively; p=0.34). The independent predictor of survival in PVT patients with decompensated cirrhosis was the degree of MPV occlusion (hazard ratio 0.189, 95% CI 0.042–0.848).

Conclusions

TIPS should be considered a safe and feasible alternative therapy for chronic PVT in selected patients with decompensated cirrhosis. Both technical success and survival were closely associated with the degree of MPV occlusion.

Abbreviations: TIPS, transjugular intrahepatic portosystemic shunt, PVT, portal vein thrombosis, MPV, main portal vein, RPV, right branch of portal vein, LPV, left branch of portal vein, SV, splenic vein, SMV, superior mesenteric vein, CDUS, color Doppler ultrasonography, CT, computed tomography, OR, odds ratio, CI, confidence interval